Our culture of over-treatment is the subject of one of the main arguments I make on this blog. To discuss it properly we need to define our terms.
according to the Free Dictionary is “the treatment of clinically insignificant disease, that is, minor or indolent illnesses that do not require aggressive or invasive therapy.” Reilly and Evans, writing in the Annals of Internal Medicine, refer to the phenomenon as “unnecessary care”, and define it as “diagnostic or treatment service that provides no demonstrable benefit to a patient.” They argued that 30% of all medical care in the United States (in 2009) might have met their definition.
I tend to employ a broader definition that encompasses what I have already referred to as The Culture of Over-Treatment: Over-testing, over-medication, over-referral (to specialists), and over-hospitalization. The common feature of these four “overs” is that they satisfy Reilly and Evans’ condition of failing to provide demonstrable benefit to a patient. The “culture” of over-treatment refers to the institutions, practices, and mind-sets that propagate unnecessary care.
Need a SLEEP COACH?
And I take the argument further. I claim not only does over-treatment fail to provide benefit, but that over-treatment does harm. Always. Sometimes the harms are small – the recipient of over-treatment isn’t physically harmed but treatment cost money that didn’t need to be spent. Or the treatment did nothing but cause anxiety. This is difficult to measure but cannot be discounted – in future posts I hope to deal more fully with the “anxiety factor.” And finally there is physical harm. It’s bad enough when people are harmed in the course of treatment that threaten life or limb: when injuries happen in the course of over-treatment, it is doubly catastrophic.
Measurement of harm in medicine is a relatively new phenomenon. Harms studies are different from mere complication rates after surgery or rates of readmission after hospitalization. Today, more attention is paid to adverse outcomes from tests and treatments previously thought to be innocuous, such as routine blood tests, or antivirals for the treatment of Influenza.
But the harms that interest me the most are more difficult to define and quantify, but are no less devastating, and these are harms related to the ways we think about ourselves: our lives, our health and wellness, and particularly the way we experience our children.
There are several excellent books on the subject, especially “Overtreated” by Shannon Brownlee, about which I have a personal story that will have to wait for a future post.
I hope the tide is turning away from the culture of over-treatment but I see no solid evidence of this happening. Talking about it is the best way I know how to buck the trend. Read on.